Management of a Paraphimosis

1. Management of a Paraphimosis Dr. P.T.Kenny.

2. Introduction • Paraphimosis implies the inability of the retracted constricting foreskin to be reduced over the glans. • Oedema distal to the constriction is a complicating factor which has to be addressed. • Reduction is painful without some form of anesthesia and can also be time consuming when using certain techniques. • Reduction can be done in theatre under GA, or in a consulting room under local anesthesia. • (Phimosis is a constriction of the foreskin which cannot be retracted).

5. Reduction of the paraphimosis • You need to obtain the patient’s co-operation and trust in you. • Explain your planned actions to the patient. • Using 1or 2% lignocaine (without adrenaline!!), do a ring block at the base of the penis. • Clean the glans with Hibitane in water. • Then puncture a few holes in the oedematous tissue, using a 21G needle. • Cover the glans with gauze swabs or a piece of linen saver. • Now squeeze the glans firmly to drain the oedema. • Retract the foreskin over the glans of the penis. • A circumcision can be planned for later if deemed necessary. • Sometimes it is necessary to cut through the constricting band dorsally (the penis is then already anaesthetized).

6. Remarks • Never attempt this procedure without first doing a ring block of the penis. • Don’t ask unnecessary questions! And keep your comments to yourself! • The young man (patient) feels guilty and ashamed enough!!!